Diagnosis and management of hyperprolactinemia

Hyperprolactinemia is a common disorder that occurs in both men and women. It is typically caused by a prolactin (PRL)-secreting microadenoma. However, other pathologic and physiologic processes and pharmacologic agents may cause hyperprolactinemia. Diagnostic imaging is recommended when physiologic and pharmacologic causes of excessive PRL secretion are excluded. Therapeutic goals for hyperprolactinemia include resolution of symptoms and normalization of PRL concentrations. If a tumor is present, goals also include tumor mass reduction. Pharmacotherapy with dopamine agonists is the treatment of choice, even in patients with macroprolactinomas. These agents are able to resolve galactorrhea, promote the resumption of menses, and reverse hypogonadism; in many cases, they also reduce tumor size. Currently, two medications are US Food and Drug Administration (FDA) approved for the treatment of hyperprolactinemia. Bromocriptine requires twice-daily dosing, and cabergoline requires once- or twice-weekly dosing. Surgery is considered second-line therapy for prolactinoma in patients who fail or cannot tolerate dopamine agonist therapy.